Application of the Updated Cardiogenic Shock Working Group SCAI Classification for Cardiogenic Shock: A Single-Centre...

Area of Science:

• Cardiology
• Critical Care Medicine
• Health Outcomes Research

Background:

• The Society for Cardiovascular Angiography and Interventions (SCAI) proposed a cardiogenic shock (CS) severity classification in 2019.
• The Cardiogenic Shock Working Group (CSWG) refined this classification in 2022 to improve CS stratification.

Purpose of the Study:

• To evaluate the in-hospital mortality rates across different severity stages of cardiogenic shock (CS) using the SCAI-CSWG classification.
• To assess the utilization of temporary mechanical circulatory support based on CS severity.

Main Methods:

• Retrospective analysis of 742 consecutive patients with CS managed at a quaternary academic medical center (May 2015 - December 2021).
• In-hospital mortality and temporary mechanical circulatory support use were assessed per SCAI-CSWG stage at shock onset.
• Included devices: intra-aortic balloon pump, percutaneous ventricular assist device, and venoarterial extracorporeal membrane oxygenation.

Main Results:

• In-hospital mortality increased with higher SCAI-CSWG stages: 14.30% (Stage B), 20.90% (Stage C), 32.70% (Stage D), and 44.80% (Stage E).
• Temporary mechanical circulatory support use was highest in the most severe SCAI stage (Stage E).
• The cohort had a median age of 62 years, predominantly male (66%), with 25% acute myocardial infarction and 75% non-acute myocardial infarction as CS etiology.

Conclusions:

• A direct relationship exists between in-hospital mortality and cardiogenic shock severity as defined by the SCAI-CSWG classification.
• These findings support the SCAI-CSWG classification's utility in predicting outcomes for CS patients.
• Further validation through prospective studies is warranted.